After two months of resting due to some muscle tension in my right glutes, I finally started working on those muscles again. It was my first leg day at the gym, and I decided to do squats with an empty barbell. There is a mirror wall on the right so people can check their moves when working out. As I flexed my body to the lowest point that I could reach, I looked into the mirror to check if my position was correct. And guess what? I was terrified by something I didn’t expect - substantial bumpy and lumpy skin on the side of my thigh!
Even though it was a shock to me at that moment, I didn’t take it very seriously afterward, which was probably what everybody else’s reaction before that term “cellulite” was even invented. It was until one day I accidentally saw something called anti-cellulite leggings online that made me want to know more about this orange peel on my skin.
What Is Cellulite?
Cellulite is the rippling and dimpling of skin, usually observed in buttocks, back of thighs, belly and upper arms, where our body tends to store fat. An estimation of 80% to 98% of post pubertal women have cellulite, while it is rare in heathy men. 
The medical terms for cellulite include dermopanniculosis deformans, adiposis edematosa, status protrusus cutis and gynoid lipodystrophy.
Cellulite and Cellulitis
Cellulite and cellulitis are two totally different skin conditions. Cellulite is the rippling and dimpling of the skin, which is a harmless skin condition that is very common among women and doesn’t require medical treatment. On the other hand, cellulitis is a skin infection on lower legs, in the face, arms or other areas. Skin affected by cellulitis appears swollen and red and is typically painful and warm to touch. Cellulitis requires medical treatment.
This article is about cellulite, not cellulitis.
What Causes Cellulite?
Although research has been ongoing, the “culprit” of cellulite is currently said to be the fibrous septa, bundles of connective tissues originated from collagen fibers in our dermis, that cross the fat layer and connect the dermis to the underlying fascia.
Graphic representation of the variation in subcutaneous connective tissue
However, fibrous septa alone don’t cause cellulite. It is the structure of fibrous septa in women that causes the problem. Studies have demonstrated structural difference of the connective tissues between women and men. In men, fibrous septa are oblique, arranged in a crisscrossing manner, and are thicker and denser. In women on the other hand, fibrous septa are arranged perpendicularly to the skin. The fat layer appears to be broken into smaller chambers under such structure in men, while the chambers are wider and deeper in women. This explains why a majority of women, even skinny and fit females may have cellulite, but men even those that have high BMI don’t necessarily have it.
Male (left) and female (right) thigh skin with cellulite grade=0 (see)
The result of this structural difference is that while fibrous septa retract and restrict further movement of skin away from underlying fascia, fat chambers push the skin, which protrudes and produces this mattress like appearance. A vivid description of this structural difference is that, in men it is like a person wearing normal tights as in women it is like wearing fishnet tights.
It is also said that hormones, genetics and loss of collagen are factors contributing to the appearance of cellulite.
Is Cellulite Fat?
Cellulite is not fat. It is instead a structural phenomenon and a common condition in women, as explained earlier. Yet increase storage of fat can exacerbate the condition, and there are many examples of women improving the appearance of cellulite through steady weight loss.
Cellulite Severity Grading
Before going into the remedies, let’s first take a look at cellulite grading.
The Nürnberger and Müller scale classifies cellulite into three grades with the second and third grade further classified into mild, moderate and severe:
Grade I – skin is smooth at rest
Grade II – skin demonstrates a mattress or orange-peel appearance at rest
Grade III – Grade II plus nodules intermixed with raised and depressed area at rest
Other cellulite severity gradings such as Rossi scale, and cellulite severity scale (CSS) that are similar to the Nürnberger and Müller scale are also used.
How to Get Rid of Cellulite?
There are different treatments for cellulite, for example topical agents, energy-based devices, subcision and more.
Topical agents such as creams containing caffeine or retinol or both and massages apply directly on skin are reported to improve cellulite severity. Yet studies accessing the durability of such methods said they were short term (less than two weeks).
Energy-based devices such as extracorporeal shock wave therapy (ESWT), radiofrequency, laser- and light-base devices that promote tissue changes seem to show better improvement and longer durability (up to 2 years).
Subcision including manual subcision, vacuum-assisted subcision and laser-assisted subcision that release the fibrous septa so far has the most durable improvements in cellulite severity (up to 5 years). Although subcision is not applicable for people with Grade I cellulite.
Cellulite treatments can be costly, and some of them require multiple sessions. Even topical creams, in order to create a long-lasting effect, one has to apply them on a consistent basis, and that adds up. Plus, you might already be wondering if there is a more natural and less costly home remedy to reduce cellulite.
Toning up muscles specifically not only burn more calories, but also promote cell regeneration and tighten the skin through increased metabolic rate, therefore making cellulite less noticeable.
So, can you get rid of cellulite? The answer is yes, and no. Numerous treatments and methods have been proposed and used to treat cellulite with various results. Yet none of them appear to be permanent so far.
P.S. Don’t even think about those so called "anti-cellulite" bubble leggings. They might hide cellulite, but they can neither reduce it nor completely eradicate it.
 Lawrence S Bass, Michael S Kaminer, “Insights Into the Pathophysiology of Cellulite: A Review”, Dermatol Surg. 2020 Oct;46 Suppl 1: S77-S85. doi: 10.1097/DSS.0000000000002388.
 “Anatomy of subcutaneous structures in areas with and without cellulite by magnetic resonance images”, SKIN ANATOMY, EMBRYOLOGY, AND PHYSIOLOGY| VOLUME 58, ISSUE 2, SUPPLEMENT 2, AB135, FEBRUARY 01, 2008, DOI: https://doi.org/10.1016/j.jaad.2007.10.597.
 Roberto Amore, Domenico Amuso, Vincenza Leonardi, Andrea Sbarbati, Giamaica Conti, Maria Albini, Francesco Leva, Ferdinando Terranova, Antonio Guida, Konstantinos, Gkritzalas, Liya Gavashely, Roman Velichenko, “Treatment of Dimpling from Cellulite”, Plast Reconstr Surg Glob Open. 2018 May 18;6(5):e1771. doi: 10.1097/GOX.0000000000001771. eCollection 2018 May.
 F. Mirrashed, J. C. Sharp, V. Krause, J. M. Morgan, B. Tomanek, “Pilot study of Dermal and Subcutaneous Fat Structures by MRI in Individuals that differ in Gender, BMI, and Cellulite Grading”, Proc. Intl. Soc. Mag. Reson. Med. 11 (2003).
 See 1.
 See 3.
 See 5.
 See 4.